Single tunnel, double bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone grafts

ABSTRACT

Anterior cruciate ligament reconstruction methods and devices are designed to achieve an anatomically accurate double bundle anterior cruciate ligament reconstruction by using a single femoral and tibial tunnel. The method and devices reconstruct the two bundles of the anterior cruciate ligament in a single femoral and tibial tunnel using a bone-patellar tendon-bone graft. The methods and devices enable an accurate anatomical reconstruction of the anteromedial and posterolateral bundles by creating a single femoral and tibial tunnel as opposed to creating two tunnels in the tibia and femur.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a divisional application of U.S. Ser. No. 13/122,845filed Apr. 6, 2011, which is a national phase of PCT InternationalApplication PCT/US2009/060466 filed Oct. 13, 2009, which claims priorityfrom U.S. Patent Application 61/104,876 filed Oct. 13, 2008, all ofwhich are incorporated herein by reference for all purposes.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH

Not Applicable.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to methods and devices for ligament reconstructionin a joint. More particularly, the invention relates to a method and animplant to anatomically reconstruct the two bundles of the anteriorcruciate ligament in a single femoral and tibial tunnel using abone-patellar tendon-bone graft.

2. Description of the Related Art

There is a high prevalence of traumatic anterior cruciate ligament (ACL)injuries both in athletic and non-athletic population. ACLreconstruction is commonly performed to replace the injured ACL.However, osteoarthritis and knee pain have been reported among patientswho had an ACL reconstruction 20 surgery. (See, Aglietti et al., “Longterm study of anterior cruciate ligament reconstruction for chronicinstability using the central one-third patellar tendon and a lateralextraarticular tenodesis” Am J Sports Med. 1992; 20:38-45; Jomha et al.,“Long-term osteoarthritic changes in anterior cruciate ligamentreconstructed knees” Clin Orthop Relat Res. 1999; 188-193; andPinczewski et al., “A five-year 25 comparison of patellar tendon versusfour-strand hamstring tendon autograft for arthroscopic reconstructionof the anterior cruciate ligament” Am J Sports Med. 2002; 30:523-536).Improving ACL reconstruction techniques that may restore normal kneestability and prevent joint degeneration remains a subject of continuingdebate in sports medicine research.

Single bundle AOL reconstruction has been adopted by many surgeons.However, studies have shown that single bundle ACL reconstruction failsto restore tibial rotation to the intact level. (See, Georgoulis et al.,“Tibial rotation is not restored after ACL reconstruction with ahamstring graft” Clin Orthop Relat Res. 2007; 454:89-94; and Ristanis etal., “Follow-up evaluation 2 years after ACL reconstruction withbone-patellar tendon-bone graft shows that excessive tibial rotationpersists” Clin J Sport Med. 2006; 16:111-116). These observations areattributed to the limitation of single bundle ACL reconstruction toreproduce both the functional bundles (anteromedial (AM) andposterolateral (PL)) of the ACL. In order to address this issue, doubletunnel-double bundle ACL reconstruction was introduced to reconstructthe two functional bundles of the ACL. There is no consensus among thestudies in literature showing a significant advantage of this techniqueover the conventional single bundle ACL reconstruction. Although thedouble tunnel-double bundle ACL reconstruction technique is capable ofreproducing the two functional bundles, it is a technically challengingprocedure. The double tunnel-double bundle ACL reconstruction is alsoassociated with an increase in the duration of surgery and higher costas compared to the traditional single bundle ACL reconstruction. (See,Caborn et al., “Single femoral socket double-bundle anterior cruciateligament reconstruction using tibialis anterior tendon: description of anew technique” Arthroscopy 2005; 21:1273; and Yasuda et al., “Anatomicreconstruction of the anteromedial and posterolateral bundles of theanterior cruciate ligament using hamstring tendon grafts” Arthroscopy2004; 20:1015-1025). In addition, the double tunnel-double bundle ACLreconstruction makes a revision surgery difficult. By drilling twotunnels, there is an elevated risk of bone bridge damage due to anexcessive loss of bone. These limitations in the current designs of theACL reconstruction techniques leave a large scope for an improvement tothis surgery.

Therefore, there is a need for improved methods and improved devices foranterior cruciate ligament reconstruction.

SUMMARY OF THE INVENTION

The present invention provides a dramatic improvement to current ACLreconstruction techniques. This invention is designed to achieve ananatomically accurate double bundle ACL reconstruction by using a singlefemoral and tibial tunnel. In the invention, there has been developed amethod and an implant to anatomically reconstruct the two bundles of theACL in a single femoral and tibial tunnel using a bone-patellartendon-bone graft.

The bone-patellar tendon-bone graft is split longitudinally to form thetwo bundles of the ACL. The graft could be split from one end to theother forming two separated bundles or 3 to 4 centimeters of the graftcould be split on both ends of the graft leaving the graft attached atthe intermediate section, as described further below.

ACL reconstruction using the implant can be performed either by singleincision or double incision techniques (See, Bach et at,“Single-incision endoscopic anterior cruciate ligament reconstructionusing patellar tendon autograft. Minimum two-year follow-up evaluation”Am J Sports Med. 1998; 26(1):30-40; Gill et al., “Anterior cruciateligament reconstruction the two-incision technique” Orthop Clin NorthAm. 2002; 33(4):127-735). The femoral and tibial tunnels are placed in astandard fashion as in the case of single bundle ACL reconstruction. Thefixation plates of the implant described in detail below are attached tothe four bone blocks of the split bone-patellar tendon-bone graft viasutures.

Double bundle ACL reconstruction can be achieved by fixing the ends ofthe graft in the femoral and tibial tunnels by placing the interferencescrews between the fixation plates. Graft bundles are rotated until ananatomic orientation is achieved before fixing the graft in the tunnels.

The implant of the present invention enables an accurate anatomicalreconstruction of the AM and PL bundles by creating a single femoral andtibial tunnel as opposed to creating two tunnels in the tibia and femur.The surgical procedure to use this implant is related to single bundleACL reconstruction that is currently being used by majority of surgeons.Hence, ACL reconstruction using this implant could be performed withgreat ease by any surgeon practicing single bundle ACL reconstruction. Arevision surgery could be performed with fewer complications than doubletunnel-double bundle ACL reconstruction.

In one aspect, the invention provides an implant for ligamentreconstruction in a joint. The implant includes a ligament replacementhaving a first strand, a second strand, a first bone block, and a secondbone block. The first strand and the second strand are spaced apart at afirst end section of the ligament replacement, and the first strand andthe second strand are spaced apart at a second opposite end section ofthe ligament replacement. The first bone block is attached to the firststrand at the first end section of the ligament replacement, and thesecond bone block is attached to the second strand at the first endsection of the ligament replacement. A first fixation device ispositioned between the first bone block and the second bone block. Thefirst bone block, the second bone block, and the first fixation deviceare dimensioned such that the first fixation device presses an outersurface of the first bone block against an inner surface of a tunnel ina first bone of the joint and presses an outer surface of the secondbone block against the inner surface of the tunnel in the first bone ofthe joint when the first fixation device is positioned between the firstbone block and the second bone block.

The ligament replacement can include a third bone block attached to thefirst strand of the ligament replacement at the second end section ofthe ligament replacement, and a fourth bone block attached to the secondstrand of the ligament replacement at the second end section of theligament replacement. A second fixation device can be positioned betweenthe third bone block and the fourth bone block. The third bone block,the fourth bone block, and the second fixation device are dimensionedsuch that the second fixation device presses an outer surface of thethird bone block against an inner surface of a tunnel in a second boneof the joint and presses an outer surface of the fourth bone blockagainst the inner surface of the tunnel in the second bone of the jointwhen the second fixation device is positioned between the third boneblock and the fourth bone block.

In one form, the first fixation device includes (i) a first fixationplate and a second fixation plate spaced apart from the first fixationplate, and (ii) a first interference screw positioned between the firstfixation plate and the second fixation plate of the first fixationdevice. The first fixation plate of the first fixation device contactsthe first interference screw and an inner surface of the first boneblock when the first fixation device is positioned between the firstbone block and the second bone block, and the second fixation plate ofthe first fixation device contacts the first interference screw and aninner surface of the second bone block when the first fixation device ispositioned between the first bone block and the second bone block.

In one form, the second fixation device includes (i) a third fixationplate and a fourth fixation plate spaced apart from the third fixationplate, and (ii) a second interference screw positioned between the thirdfixation plate and the fourth fixation plate of the second fixationdevice. The third fixation plate of the second fixation device contactsthe second interference screw and an inner surface of the third boneblock when the second fixation device is positioned between the thirdbone block and the fourth bone block, and the fourth fixation plate ofthe second fixation device contacts the second interference screw and aninner surface of the third bone block when the second fixation device ispositioned between the third bone block and the fourth bone block.

The first fixation plate and the second fixation plate of the firstfixation device can be integral. Alternatively, the first fixation plateand the second fixation plate of the first fixation device are notconnected. The first fixation plate of the first fixation device can besutured to an inner surface of the first bone block, and the secondfixation plate of the first fixation device can be sutured to an innersurface of the second bone block.

The third fixation plate and the fourth fixation plate of the secondfixation device can be integral. Alternatively, the third fixation plateand the fourth fixation plate of the second fixation device are notconnected. The third fixation plate of the second fixation device can besutured to an inner surface of the third bone block, and the fourthfixation plate of the second fixation device can be sutured to an innersurface of the fourth bone block.

Any of the fixation plates can include one or more ribs on their outersurface for engaging an inner surface of the associated bone block. Anyof the fixation plates can include one or more throughholes forreceiving a suture. An inner wall of the first fixation plate and aninner wall of the second fixation plate of the first fixation device canbe tapped to engage threads of the first interference screw. An innerwall of the third fixation plate and an inner wall of the fourthfixation plate of the second fixation device can be tapped to engagethreads of the second interference screw. Any of the fixation plates caninclude a first end and a opposite second end wherein an inner wall ofthe fixation plate is thicker adjacent the first end of the fixationplate than adjacent the second end of the fixation plate.

In one form, the first strand and the second strand are connected at anintermediate section of the ligament replacement. In another form, thefirst strand and the second strand are not connected. The first strandand the second strand can be selected from a patellar tendon, ahamstring tendon, an Achilles tendon, or a tibialis tendon. In yetanother form, the ligament replacement is a bone-patellar tendon-bonegraft split on both ends of the graft.

The tunnel in the first bone and the tunnel in the second bone can beprepared by a single incision anterior cruciate ligament reconstructiontechnique. Alternatively, the tunnel in the first bone and the tunnel inthe second bone can be prepared by a two incision anterior cruciateligament reconstruction technique.

In one use of the implant, the first bone is the femur, the second boneis the tibia, and the ligament is the anterior cruciate ligament. Inanother use of the implant, the first bone is the femur, the second boneis the tibia, and the ligament is the posterior cruciate ligament.

In another aspect, the invention provides a method for ligamentreconstruction in a joint. In the method, a ligament replacement havinga first strand, a second strand, a first bone block, a second boneblock, a third bone block, and a fourth bone block is obtained. Thefirst strand and the second strand are spaced apart at a first endsection of the ligament replacement, and the first strand and the secondstrand are spaced apart at a second opposite end section of the ligamentreplacement. The first bone block is attached to the first strand at thefirst end section of the ligament replacement, the second bone block isattached to the second strand at the first end section of the ligamentreplacement, the third bone block is attached to the first strand of theligament replacement at the second end section of the ligamentreplacement, and the fourth bone block is attached to the second strandof the ligament replacement at the second end section of the ligamentreplacement. The ligament replacement can be obtained by splitting afirst end of a bone-patellar tendon-bone graft longitudinally to formone end of the first strand, one end of the second strand, the firstbone block, and the second bone block, and splitting a second end of thebone-patellar tendon-bone graft longitudinally to form an opposite endof the First strand, an opposite end of the second strand, the thirdbone block, and the fourth bone block.

A first fixation device is positioned between the first bone block andthe second bone block, and a second fixation device is positionedbetween the third bone block and the fourth bone block. A first tunnelis formed in a first bone of the joint, and a second tunnel is formed ina second bone of the joint. The first bone block, the second bone block,and the first fixation device are located in the first tunnel, and theouter dimension of the first fixation device is adjusted such that thefirst fixation device presses an outer surface of the first bone blockagainst an inner surface of the first tunnel and presses an outersurface of the second bone block against the inner surface of the firsttunnel. The third bone block, the fourth bone block, and the secondfixation device are located in the second tunnel, and the outerdimension of the second fixation device is adjusted such that the secondfixation device presses an outer surface of the third bone block againstan inner surface of the second tunnel and presses an outer surface ofthe fourth bone block against the inner surface of the second tunnel. Inone use of the method, the first bone is the femur, the second bone isthe tibia, and the ligament being reconstructed is the anterior cruciateligament.

The first fixation device can include a first fixation plate, a secondfixation plate spaced apart from the first fixation plate, and a firstinterference screw. The second fixation device can include a thirdfixation plate, a fourth fixation plate spaced apart from the thirdfixation plate, and a second interference screw. The step of adjustingthe outer dimension of the first fixation device can comprise drivingthe first interference screw between the first fixation plate and thesecond fixation plate such that the first fixation plate presses theouter surface of the first bone block against the inner surface of thefirst tunnel and the second fixation plate presses the outer surface ofthe second bone block against the inner surface of the first tunnel. Thestep of adjusting the outer dimension of the second fixation device cancomprise driving the second interference screw between the thirdfixation plate and the fourth fixation plate such that the thirdfixation plate presses the outer surface of the third bone block againstthe inner surface of the second tunnel and the fourth fixation platepresses the outer surface of the fourth bone block against the innersurface of the second tunnel.

The step of positioning the first fixation device between the first boneblock and the second bone block can include suturing the first fixationplate of the first fixation device to the first bone block, and suturingthe second fixation plate of the fixation device to the second boneblock. The step of positioning the second fixation device between thethird bone block and the fourth bone block can include suturing thethird fixation plate of the second fixation device to the third boneblock, and suturing the fourth fixation plate of the second fixationdevice to the fourth bone block.

In the method, the first fixation device can be rotated until ananatomic orientation of the first strand and the second strand isachieved before driving the first interference screw between the firstfixation plate and the second fixation plate. Likewise, the secondfixation device can be rotated until an anatomic orientation of thefirst strand and the second strand is achieved before driving the secondinterference screw between the third fixation plate and the fourthfixation plate.

In one version of the method, the first interference screw and thesecond interference screw are driven in substantially the samedirection. In another version of the method, the first interferencescrew and the second interference screw are driven in substantiallyopposite directions. The steps of forming the first tunnel in the firstbone of the joint and forming the second tunnel in the second bone ofthe joint can comprise preparing the first tunnel in the first bone andthe second tunnel in the second bone by a two incision anterior cruciateligament reconstruction technique. The steps of forming the first tunnelin the first bone of the joint and forming the second tunnel in thesecond bone of the joint can comprise preparing the first tunnel in thefirst bone and the second tunnel in the second bone by a single incisionanterior cruciate ligament reconstruction technique.

These and other features, aspects, and advantages of the presentinvention will become better understood upon consideration of thefollowing detailed description, drawings, and appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a side view schematic of a fixation device of an implantaccording to the invention including two fixation plates and aninterference screw.

FIG. 2 shows a detailed perspective view of the fixation plates of thefixation device of FIG. 1.

FIG. 3 shows the inner wall architecture of the two fixation plates ofFIGS. 1 and 2.

FIG. 4 shows a schematic of a bone-patellar tendon-bone graft split intotwo bundles on either ends with the intermediate section attached andboth the ends fixed onto the fixation plates via sutures in accordancewith the invention.

FIG. 5 shows a perspective view of the bone-patellar tendon-bone graftwith the fixation plates attached after the interference screw isinserted in between them in accordance with the invention.

FIG. 6 shows a schematic of a bone-patellar tendon-bone graft split intotwo bundles from one end to the other, with the ends fixed onto thefixation plates via sutures in accordance with the invention.

FIG. 7 shows a schematic of the bone-patellar tendon-bone graft with thefixation plates attached after the interference screw is inserted inbetween them in accordance with the invention.

FIG. 8 shows a schematic of a bone-patellar tendon-bone graft attachedto the fixation plates of the implants as used in single incision ACLreconstruction technique in accordance with the invention.

FIG. 9 shows a schematic of the bone-patellar tendon-bone graft with thefixation plates attached after the interference screw is inserted inbetween them as used in single incision ACL reconstruction technique inaccordance with the invention.

FIG. 10 shows a perspective view of an anatomical reconstruction of theACL that reproduces the positioning of anteromedial and posterolateralbundles using the bone-patellar tendon-bone graft of FIG. 7.

Like reference numerals will be used to refer to like parts from Figureto Figure in the following description of the drawings.

DETAILED DESCRIPTION OF THE INVENTION

The invention is capable of fixing the two graft bundles in the anatomicpositions of anteromedial and posterolateral bundles by placing a singlefemoral and tibial tunnel. This anterior cruciate ligamentreconstruction is a minimally invasive surgery that can be performedarthroscopically. Although the description of the invention is targetedtowards anterior cruciate ligament reconstruction, the present inventioncould potential be adapted for, but not limited to, posterior cruciateligament reconstruction and other ligament reconstructions in variousjoints. Anterior cruciate ligament reconstruction using the presentinvention can be accomplished by surgeons who are familiar with singlebundle ACL reconstruction.

Embodiments of the invention feature two implants 69, 78 and abone-patellar tendon-bone graft 68 to reconstruct the two bundles of theACL. In one version of the invention, the bone-patellar tendon-bonegraft 68 can be obtained by removing the central portion of thepatient's patellar tendon using a scalpel and motorized tool. The endsof the patellar tendon are attached to bone blocks from the patient'spatella and tibia. First implant 69 includes fixation plates 19, 20 andan interference screw 10. The second implant features similar fixationplates 60, 61 and an interference screw 47 as in the first implant 69.In one of the forms, the bone-patellar tendon-bone graft 68 is splitfrom one end to the other and used with the implants 69, 78. In otherembodiment, the bone-patellar tendon-bone graft 68 is split only by 3 to4 centimeters on either ends leaving the intermediate section 46 intactand fixed with the implants 69, 78 in the tibial tunnel 65 and femoraltunnel 66. The architecture of only the first implant 69 is described indetail below since both the implants 69, 78 have the same architecturein the example embodiment.

Referring to FIGS. 1-5, the first implant 69 includes two fixationplates 19, 20 and an interference screw 10. The outer walls 17, 22 ofthe fixation plates 19, 20 include rib like protrusions 21, 23 toprevent any slippage between the first and second bone blocks 38, 42 andthe fixation plates 19, 20. Throughholes 27 running from outer wall 17to the inner wall 71 are present on one side of the fixation plate 20 toattach the bone blocks 38 of the bone-patellar tendon-bone graft 68 viasutures 57. Throughholes 28 running from outer wall 17 to the inner wall71 are present on an opposite side of the fixation plate 20 to attachthe bone blocks 38 of the bone-patellar tendon-bone graft 68 via sutures57. Fixation plate 19 has throughholes 33 running from the outer wall 22to the inner wall 70 on one side of the fixation plate 19 to attach thebone block 42 of the bone-patellar tendon-bone graft 68 via sutures 56.Fixation plate 19 has throughholes 34 running from the outer wall 22 tothe inner wall 70 on an opposite side of the fixation plate 19 to attachthe bone block 42 of the bone-patellar tendon-bone graft 68 via sutures56.

Throughholes 29, 30 are present on the fixation plates 20, 19respectively to pass strands of sutures 48, 51 used to apply tension tothe graft 68. Throughholes 45, 15 are present on the fixation plates 19,20 respectively to pass strands of sutures 100, 101 that will be used toapply tension to the graft 68 while using a single incision ACLreconstruction technique. The inner walls 16, 18 of the fixation plates20, 19 respectively have a variable thickness to match the variablediameter of the interference screw 10 (see FIG. 1). This prevents thefixation plates 19, 20 from collapsing at the posterior ends 24, 25 andhelps to maintain a desired separation between the graft bundles 40, 44.

Referring to FIG. 1, the interference screw 10 includes threads 11 thatrun along the entire length of the screws 10. The diameter of theinterference screw 10 is larger at the anterior end 72 than thediameters at the posterior end 73. The interference screws 10 and thefixation plate 19 include a flat cut 12, 14 at the posterior end 73 andanterior end 13 respectively to allow easy insertion of the interferencescrews 10 between the fixation plates 19, 20.

Referring to FIG. 3, the inner walls 16, 18 of the fixation plates 19,20 are tapped 31, 35 to accommodate the threads 11 of the interferencescrews 10. Protrusions 26 and 37 are inserted into the throughholes 32and 36 respectively to attach the fixation plates 19, 20 together beforethe interference screw 10 is inserted between the inner walls 16, 18 ofthe fixation plates 19, 20.

Referring to FIGS. 4-7, a bone-patellar tendon-bone autograft orallograft 68 is preferred for reconstructing the functional bundle ofthe ACL. However, other graft materials such as hamstring tendon,Achilles tendon or tibialis tendon can also be used with the presentinvention. The bone-patellar tendon-bone graft 68 is splitlongitudinally by an oscillating saw either the entire length of thegraft 68, or by 3 to 4 centimeters on both of the ends of the graft 68as preferred by the surgeon to form two graft bundles 40,44.

Referring to FIG. 10, a schematic of the knee joint 64 is shown withfemur 67, tibia 63 and fibula 62. The tibial tunnel 65 and the femoraltunnel 66 are prepared in standard fashion either by single incision ordouble incision ACL reconstruction techniques.

Referring to FIG. 6-7, an example embodiment of implants 69, 78according to the invention for ligament reconstruction is shown. Theimplant 69 includes a ligament replacement 68 having a first end section74, and a second end section 75. The ligament replacement 68 includes afirst strand 44 and a second strand 40. The first strand 44 and thesecond strand 40 are spaced apart at the first end section 74 of theligament replacement 68. The first strand 44 and the second strand 40are spaced apart at the second end section 75 of the ligamentreplacement 68. The ligament replacement 68 can comprise a patellartendon, a hamstring tendon, an Achilles tendon, or a tibialis tendonautograft or allograft.

Implant 69 includes a first fixation plate 19 and a second fixationplate 20 spaced apart from the first fixation plate 19. The firstfixation plate 19 and the second fixation plate 20 are shown as separatecomponents; however, they could be formed integrally. Implant 69 alsoincludes an interference screw 10 inserted between the first fixationplate 19 and the second fixation plate 20 of the first implant 69. Thefirst fixation plate 19 of the implant 69 contacts the interferencescrew 10 and a surface of the first bone block 42 when the implant 69 ispositioned between the first bone block 42 and the second bone block 38.The second fixation plate 20 of the implant 69 contacts the interferencescrew 10 and a surface of the second bone block 38 when the implant 69is positioned between the first bone block 42 and the second bone block38. Suture 56 connects the first fixation plate 19 of the implant 69 tothe first bone block 42, and suture 57 connects the second fixationplate 20 of the implant 69 to the second bone block 38.

The first implant 69 is positioned between the first bone block 42 andthe second bone block 38. When the fixation device 69 is positionedbetween the first bone block 42 and the second bone block 38, theimplant 69 presses an outer surface 76 of the first bone block 42against an inner surface of a tunnel 66 in the femur 67 of the kneejoint 64, and the implant 69 presses an outer surface 77 of the secondbone block 38 against the inner surface of the tunnel 66 in the femur 67of the knee joint 64.

A second implant 78 is positioned between the third bone block 43 andthe fourth bone block 41. When the implant 78 is positioned between thethird bone block 43 and the fourth bone block 41, the implant 78 pressesan outer surface 80 of the third bone block 43 against an inner surfaceof a tunnel 65 in the tibia 63 of the knee joint 64 and the implant 78presses an outer surface 79 of the fourth bone block 41 against an innersurface of the tunnel 65 in the tibia 63 of the knee joint 64.

The implant 78 includes a first fixation plate 60 and a second fixationplate 61 spaced apart from the first fixation plate 60. The firstfixation plate 60 and the second fixation plate 61 are shown as separatecomponents; however, they could be formed integrally. The implant 78also includes an interference screw 47 inserted between the firstfixation plate 60 and the second fixation plate 61 of the implant 78.The first fixation plate 60 of the implant 78 contacts the interferencescrew 47 and a surface of the third bone block 43 when the implant 78 ispositioned between the third bone block 43 and the fourth bone block 41.The second fixation plate 61 of the implant 78 contacts the interferencescrew 47 and a surface of the fourth bone block 41 when the implant 78is positioned between the third bone block 43 and the fourth bone block41. Suture 59 connects the first fixation plate 60 of the implant 78 tothe third bone block 43, and suture 58 connects the second fixationplate 61 of the implant 78 to the fourth bone block 41.

Sutures 48, 51 will be used to pass the first bone block 42 and thesecond bone block 38 attached to the fixation plates 19, 20 respectivelythrough the tunnel 65 in the tibia 63 and placed into the tunnel 66 ofthe femur 67 for double incision ACL reconstruction technique. Forsingle incision technique, sutures 100, 101 will be used to pass thefirst bone block 42 and the second bone block 38 attached to thefixation plates 19, 20 respectively through the tunnel 65 in the tibia63 and placed into the tunnel 66 of the femur 67. The two strands 40, 44are rotated until an anatomic orientation is achieved before theinterference screw 10 is inserted between the fixation plates 19, 20 ofthe implant 69. A first insert (interference screw 10) is then insertedby a driver between the first fixation plate 19 and the second fixationplate 20 of the implant 69. As the interference screw 10 is driventoward the posterior ends 24, 25 of the fixation plates 19, 20, thefixation plates 19, 20 move away from each other thereby pressing theouter surface 76 of the first bone block 42 against an inner surface ofa tunnel 66 in the femur 67 of the knee joint 64 and pressing the outersurface 77 of the second bone block 38 against the inner surface of thetunnel 66 in the femur 67 of the knee joint 64. The first bone block 42and the second bone block 38 heal against the tunnel 66 in the femur 67(“bone to bone” healing). The third bone block 43 and the fourth boneblock 41 attached to the fixation plates 60, 61 respectively are placedinto the tunnel 66 in the tibia 63. The two strands 40, 44 are orientedanatomically before the interference screw 47 is inserted between thefixation plates 60, 61 of the implant 78. While applying an axial grafttension of 40 N through the sutures 52, 54, a second insert(interference screw 47) is inserted by a driver between the firstfixation plate 60 of the second implant 78 and the second fixation plate61 of the second implant 78. As the interference screw 47 is driventoward the posterior ends of the fixation plates 60, 61, the fixationplates 60, 61 move away from each other thereby pressing the outersurfaces of the third bone block 43 and the fourth bone block 41 againstthe inner surface of the tunnel 65 in the tibia 63. The third bone block43 and the fourth bone block 41 heal against the tunnel 65 in the tibia63 (“bone to bone” healing).

Thus, the invention provides methods and devices for ligamentreconstruction in a joint. More particularly, the invention provides amethod and an implant to anatomically reconstruct the two bundles of theanterior cruciate ligament in a single femoral and tibial tunnel using abone-patellar tendon-bone graft.

Although the present invention has been described in detail withreference to certain embodiments, one skilled in the art will appreciatethat the present invention can be practiced by other than the describedembodiments, which have been presented for purposes of illustration andnot of limitation. Therefore, the scope of the claims should not belimited to the embodiments described herein.

What is claimed is:
 1. A method for ligament reconstruction in a joint,the method comprising: providing a ligament replacement having a firststrand comprising a first bone block, a second strand comprising asecond bone block, the first strand and the second strand being splitapart at a first end section and at a second opposite end section of theligament replacement, the first bone block being attached to the firststrand at the first end section of the ligament replacement, and thesecond bone block being attached to the second strand at the first endsection of the ligament replacement; positioning a fixation devicebetween the first bone block and the second bone block; forming a firsttunnel in a first bone of the joint; forming a second tunnel in a secondbone of the joint; locating the first bone block, the second bone block,and the fixation device in the first tunnel; adjusting an outerdimension of the fixation device such that the fixation device isconfigured to press an outer surface of the first bone block against aninner surface of the first tunnel and the fixation device is configuredto press an outer surface of the second bone block against the innersurface of the first tunnel; and anchoring the second end section of theligament replacement in the second tunnel.
 2. The method of claim 1wherein: the fixation device includes a first fixation plate, a secondfixation plate spaced apart from the first fixation plate, and aninterference screw, and the step of adjusting the outer dimension of thefixation device comprises driving the interference screw between thefirst fixation plate and the second fixation plate such that the firstfixation plate presses the outer surface of the first bone block againstthe inner surface of the first tunnel and the second fixation platepresses the outer surface of the second bone block against the innersurface of the first tunnel.
 3. The method of claim 2 wherein: the stepof positioning the fixation device between the first bone block and thesecond bone block comprises suturing the first fixation plate of thefixation device to the first bone block, and suturing the secondfixation plate of the fixation device to the second bone block.
 4. Themethod of claim 3 wherein: the step of adjusting the outer dimension ofthe fixation device comprises rotating the fixation device until ananatomic orientation of the first strand and the second strand isachieved before driving the interference screw between the firstfixation plate and the second fixation plate.
 5. The method of claim 2wherein: the ligament replacement further comprises a third bone blockattached to the first strand of the ligament replacement at the secondend section of the ligament replacement, and a fourth bone blockattached to the second strand of the ligament replacement at the secondend section of the ligament replacement; the step of anchoring thesecond end section of the ligament replacement in the second tunnelcomprises positioning a second fixation device between the third boneblock and the fourth bone block, and adjusting an outer dimension of thesecond fixation device such that the second fixation device presses anouter surface of the third bone block against an inner surface of thesecond tunnel and presses an outer surface of the fourth bone blockagainst the inner surface of the second tunnel.
 6. The method of claim 5wherein: the second fixation device includes a third fixation plate, afourth fixation plate spaced apart from the first fixation plate, and asecond interference screw, and the step of anchoring the second endsection of the ligament replacement in the second tunnel furthercomprises driving the second interference screw between the thirdfixation plate and the fourth fixation plate such that the thirdfixation plate presses the outer surface of the third bone block againstthe inner surface of the second tunnel and the fourth fixation platepresses the outer surface of the fourth bone block against the innersurface of the second tunnel.
 7. The method of claim 6 wherein: the stepof anchoring the second end section of the ligament replacement in thesecond tunnel further comprises feeding a suture through a throughholein at least one of the third fixation plate and the fourth fixationplate, pulling the second fixation device in a direction away from thefirst tunnel and thereafter driving the second interference screwbetween the third fixation plate and the fourth fixation plate.
 8. Themethod of claim 6 wherein: the interference screw and the secondinterference screw are driven in substantially the same direction. 9.The method of claim 6 wherein: the interference screw and the secondinterference screw are driven in substantially opposite directions. 10.The method of claim 1 wherein: the steps of forming the first tunnel inthe first bone of the joint and forming the second tunnel in the secondbone of the joint comprise preparing the first tunnel in the first boneand the second tunnel in the second bone by two incision anteriorcruciate ligament reconstruction technique.
 11. The method of claim 1wherein: the steps of forming the first tunnel in the first bone of thejoint and forming the second tunnel in the second bone of the jointcomprise preparing the first tunnel in the first bone and the secondtunnel in the second bone by single incision anterior cruciate ligamentreconstruction technique.
 12. The method of claim 2 wherein: the firstbone is the femur; the second bone is the tibia; and the ligament beingreconstructed is the anterior cruciate ligament.
 13. The method of claim2 wherein: the step of providing the ligament replacement comprisessplitting an end of a bone-patellar tendon-bone graft longitudinally toform the first strand, the second strand, the first bone block, and thesecond bone block.